This issue could further be addressed by using radial as opposed to femoral access when carrying out pPCI. A trial found that there was a reduced incidence of major bleeding and vascular site complication with a radial approach. Events occurring in 1.4% of those treated with radial approach and 7.2% P<0.0001 of those with femoral access with a reduction in the rate of net adverse clinical events (NACE) defined as “a composite of death, myocardial infarction, stroke, and major bleeding/vascular complications” with 4.6% vs. 11% P=0.0028. Finally there was reduced rate of mortality, without statistical significance of 2.3% vs. 3.1% at 30 days and 2.3% vs. 3.6% at a 6 month follow up (15). The trial concluded that when practitioners were well …show more content…
£6,802; p=0.653 and £8442 vs. £7,731; p=0.213 respectively)”. And although initial costs of pPCI were higher, it resulted in a reduced average hospital stay of 4 days compared to that of 8.5 days with those receiving fibrinolysis. These findings were echoed by the National Infarct Angioplasty Project which concluded that pPCI was both feasible and cost effective, if delivered in a timely fashion (16, 17). The importance of time A further study of the DANAMI-2 trial focusing on timing of intervention in STEMI (18) attempted to determine the importance of system delays in treatment of patients with fibrinolysis or pPCI. It found that the effectiveness of pPCI was less sensitive to time than that of fibrinolysis, although they both showed incremented increase in absolute mortality associated with delay. Their findings are present in figure 5: These findings suggest that if pPCI is performed within 1-2 hours, it offers the best reduction in absolute mortality when compared to fibrinolysis both at 30 days with statistical significance 2.6% vs. 6.9% P=0.04, and at 8 years with a trend, 21.8% vs. 29.4% P=0.07. However when pPCI was delayed by more than 3 hours it showed mortality rate similar to that of fibrinolysis given between 1-2 hours at both 30 days and 8 years(18). This data suggests that to gain the best results from pPCI it is best to begin treatment within 120 minutes, as set out by the NICE
The ICUs are associated with over 15 million catheter days while there is indication that only 24.4% of CVC use occurs outside the ICUs (Chopra, Krein, Olmsted, Safdar & Saint, 2013). This implies that millions of patients in the ICUs are at a high likelihood of developing CLABSI
There are several surgical techniques used for total hip replacement, including the posterolateral approach, the lateral approach, the anterolateral approach, and others. For this paper I will concentrate on the posterolateral approach since it is the most common (Skinner 396). The patient is put into the lateral decubitus position with the affected side superior after anesthesia is administered and a compression stocking is placed on the unaffected limb. The skin is covered with an adhesive drape after the incision is outlined (Skinner 396). Then the hip is flexed to 45 degrees so the "incision can be made in line with the femur from approximately 10 cm proximal to the tip of the trochanter to 10 cm distal to the tip of the trochanter" (Skinner 396). The incision
PICCs lines have become well recognized as reliable central venous access devices (VADs), with lower potential for complications than short-term central venous catheters. PICCs first gained popularity in the 1980s, and their use has grown steadily since then. They were initially popular in many parts of the United States due to the need for venous access in home care patients. They have grown in popularity because of their reduction in potential complications and costs compared with short-term central venous catheters, and because PICCs can be inserted by registered nurses who have been trained in the procedure.
Staff nurses on the unit expressed their frustration with the current practice regarding the frequency of PIV catheter replacements, stating that it was “time-consuming” and contributed to “patient dissatisfaction.” The process of replacing a PIV can often be time consuming and may take multiple attempts in order to successfully insert a new PIV. Research supports a change in practice that address these concerns. A pilot study performed in 2012, by Rickard, Webster, Wallis, Marsh, McGrail, French and Whitby indicated that replacing PIV catheters only when clinically indicated did not lead to catheter-related complications, as previously
Because the US uses an estimated 150 million PIVCs annually, and catheter-related complications (CRC) are presumed to be directly related to the indwell time (Lopez et al., 2014), this study
In an article published in JACC: Cardiovascular Interventions, Doctors Madan, Halvorsen, Di Mario, Tan, Westerhout, Cantor, Le May, and Borgia explored whether patients experienced greater risk of undergoing angiography after the administration of fibrinolytic therapy. They concluded that there was not a serious risk of bleeding or death if they receive angiography within four hours of undergoing fibrinolytic therapy (Madan et al., 2015). They also suggest that the patient be moved a center that can perform PCI within 2 hours after fibrinolysis. This article suggests that although fibrinolysis can be success a patient should receive PCI treatment.
"In 2006, more than 690,000 open heart surgeries were performed in the United States. These included surgeries to correct and repair defective valves as well as coronary artery bypass surgery. As recently as 70 years ago, these surgeries would have been impossible. The heart lung machine had yet to be invented, allowing surgeons to temporarily stop and start the heart. Prior to its invention, the longest a heart could be stopped was 30 to 40 minutes---not enough time to complete extensive surgery" (Smith, 2009). Since then, a number of minimally invasive surgical procedures have been introduced that permit surgeons to perform a variety of surgeries, making smaller incisions that leave smaller scars, reduce the chance of infection, are less painful to the patient and necessitate shorter hospital stays. These include minimally invasive direct coronary artery bypass, off-pump coronary artery bypass, videoscopic surgery and robotic-assisted heart surgery.
For people with various comorbidities it would not be wise to keep inserting and discontinuing IV’s. In addition, most of these patients need to use medications that are known vesicants and can damage skin, vascular and other tissues. According to the researcher Rita Bonczek, “All patients that have multiple co-morbidities in need of regular medical follow up and management, need reliable long term vascular access to provide care” (Bonczek 2012). Notably, the key to maintain this high of reliability is the success rate of all the health
Funny, but often when surgery &/or a lesser procedure is offered to a surgeon i.e. Dr. John Peters' situation, surgeons tend to go for the noninvasive route, even though they make their money by cutting into other people to get things done and usually done better and so be like Dr. Peters and who has had 2 angioplasties and no bypass(es), at least not yet. There was a cardiac surgeon on the west coast who actually went one step further than Peters, in that not only did he have angioplasties and not coronary bypass surgery done twice and both times the cardiologists and the cardiac surgeons had strongly recommended the bypass for a better fix for him, but he also continued to
Promising results have shown that the Angio-seal VCD has excellent efficacy and safety after routine catheterization and intervention. However, clear indications of use and risk of complications need to be evaluated and monitored.
site every couple of days lessens the associated risks of the catheter. One study, as reported by MEDSURG Nursing (2016), placed 755 patients into two groups. One group was the control which had the routine rotation every 72 hours. The other group was the experimental group that only had their I.V. changed when clinically indicated. Both groups had similar results. The control group has 60 per 1,000 device days, compared to the test groups 61 per 1,000 device days. This outcome shows that there is no statistic significance between either group (p. 45). The evidence stated by Worldviews on Evidence-Based Nursing also backs the results found by MEDSURG Nursing. Morrison and Holt (2015), researched studies and found that in a nonblind randomized control test, focused on phlebitis and infiltration rates, 33% participants in the control group and 38% in the test group had to have their catheter removed because of phlebitis and infiltration (p. 190). Both of these studies and many others all come to the same conclusion that changing the catheter does not greatly affect the outcome of I.V. associated risks. Not only is this practice unnecessary it also causes a rise in healthcare
The patient is a taxi driver. Patient able to continue the current occupation. Pt will need to integrate healthy diet and exercises to everyday life.
Change is never easy. However, survival is not a luxury, it is a necessity. Peripheral arterial diseases (PAD) are required to be managed wisely or it can turn into a threat perilous threat. PAD management has 2 main goals, to lower cardiovascular risk & to improve the ability to walk.
The goal of medical management is to minimized myocardial damage, preserve myocardial function, and prevent complications. These goals are achieved by reperfusing the area by emergency use of Percutaneous Transluminal Coronary Angioplasty (PTCA) or thrombolytic medication. Minimizing myocardial damage is also accomplished by reducing myocardial oxygen demand and increasing oxygen supply with medications, oxygen administration, and bed rest.
The use of intravenous therapy in the hospitals is now considered a routine therapy. In 2016, DeVries and Valentine stated that 70% to 80% of hospital patients have peripheral intravenous lines at some time during their stay. A peripheral intravenous (PIV) line is a small hollow tube (catheter) that is inserted into a vein and can be connected to special tubing. PIV line is commonly used to administer medications or fluids directly into the vein. The article “Intravenous Therapy: A Review of Complications and Economic Considerations of Peripheral Access,” states that the history of intravenous (IV) therapy dates back to the Middle Ages. Dr. Thomas Latta pioneered the use of IV saline infusion during the cholera epidemic and in the 20th century, two world wars established a role for IV therapy as routine medical practice (Dychter, Gold, Carson, & Haller, 2012).